Summary: GAO discussed the implications of adopting the Canadian health insurance system for U.S. health care reform. GAO noted that: (1) if the United States adopted key features of the Canadian approach, it could offer health insurance to all residents without adding to national health expenditures; (2) Canada spent less on insurance, since its publicly financed single-payer system eliminated costs associated with marketing competitive health insurance policies, billing for and collecting premiums, and evaluating insurance risks; (3) in Canada, physician associations in each province controlled fees by setting reimbursement rates for services; (4) practice expenses, such as for malpractice insurance and office staff, were lower in Canada; (5) tight hospital operating budgets and restraints on acquiring expensive medical technology in Canada limited access to services and resulted in procedural delays; (6) attempts to control spending for physician and hospital services encouraged insufficient provider practices; and (7) any reform of the U.S. health care system should retain the strengths of the current health care system, such as continued development of advanced medical technology, detailed management information systems, and the flexibility to incorporate alternative service delivery mechanisms.
